Provider Demographics
NPI:1710418009
Name:BANASCHAK, EMILY (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BANASCHAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:AESCHLIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 W LOGAN ST # 368
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1437
Mailing Address - Country:US
Mailing Address - Phone:317-776-7446
Mailing Address - Fax:317-770-2793
Practice Address - Street 1:395 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1425
Practice Address - Country:US
Practice Address - Phone:317-776-7446
Practice Address - Fax:317-770-2793
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005919207R00000X
IN11019325A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine